Hiatal hernia repair WITHOUT fundo?

Hi guys need your input please:


After many months of strange and debilitating symptoms I was finally diagnosed with a "small" hiatal hernia which seems to be causing LPR and possibly affecting the vagus nerve system as well ; I have been having almost all the atypical symptoms of reflux like
-sticky excessive phlegm
-stuffy sinus
-asthma-like breathing difficulty
-pain-stuffiness in the ear
-inflammation in the larynx and esophagus, accompanied by strange digestion/absorption issues (absorption issues especially towards fat, HCI test indicate low stomach acid, possibly caused by the HH affecting the vagus nerves?)

I have tried Nexium and all the life style changes and nothing really worked, plus as we know the pills won't make the hernia go away and just mask the problems, which eventually needs to be fixed.

I would like your input/experience on the HH repair and surgery, so far I am leaning to NOT have fundoplication as there are way too many potential problems and risks (damaging/cutting the vagus nerves being one), and just have the hiatus tightened (with biologic mesh), hernia repaired and stomach pulled back in position with the esophagus attached to the diaphragm. If this doesn't work out I could always get the linx done I suppose (which is reversible) instead of risking the fundoplication?

What are your input on this? Could this provide sufficient support to stop LPR symptoms and hernia from happening again?


Thanks for your help

liang7079

Not sure that they do just hernia repairs. They used to do them years ago but I don't think surgeons do them now.

Linx can only be performed if the hernia is less than 3 cm - although it's difficult to know the size before surgery.

Maria

liang7079

If non biologic mesh is used there is a big risk it will erode into the surrounding tissue and cause more problems. The surgeons I have had and talked with no longer use synthetic mesh for HH repairs. They prefer to let it scar naturally with either a biologic mesh or just sutures.

As for not having the fundo, the HH is usually just 1 part of the problem when it comes to GERD/LPR. With they new designs of the fundo these days the problems of the past post surgery have been drastically reduced. Myself, I'd rather them take care of both issues and not have to go back in if just the HH repair doesn't work.

Take care,
Bill

I just posted part of this this on the previous message this morning but it seems to apply to your questions as well....

I had motility issues as well, but mine turned out to be the result of the HH. I am not an expert as far as motility goes, but in my case part of my stomach was above the diaphragm and the LES was not able to close. In effect, I could swallow, but when the food reached the LES it would free-fall from there. During the Barium swallow X-ray/fluroscopic tests, the Radiologist could see the Barium refluxing back into my esophagus when he moved me from verticule to the horizontal position. He diagnosed a medium sized HH and referred me to surgery. Shortly thereafter I had the motility swallow test.

During that test, everything went smoothly the first time but the readings were all screwed up. The probe went down the first time without a hitch. However after it was down, the technician had to fish around quite awhile to try to get it to what he thought was the proper depth. The next day I had to go back and do it all again because the Gastroenterologist who evaluated the test knew something was wrong with the readings. He suspected that the probe went down until it hit the upper part of the HH and curved around and started back up. As it turned out he was correct.

He conducted the re-test himself and had his entire Gastroenterology staff as an audience.......naturally it did not go smoothly....I barfed and gagged the whole time....but he recognized when the probe started to curve around again and managed to fish it into the proper position.

By itself, repairing the HH could have eliminated the problem. However, in order to prevent recurrance, they insisted on also doing the NF wrap. I really was worried about that part of the operation but it all worked out fine. I had an easy recovery and have been symptom free since the repair was done in March of this year.

AS far as the operation for the wrap goes, the dangers you mention are already past when they repair the HH. They have already invaded and "insulted" your abdomen as much as they are going to just to gain access to your esophagus. They do the wrap on the way out. I dont want to minimize the proceedure...but in my case, the wrap was done as insurance to prevent recurrance. They put three sutures in the Hiatus of the diaphragm to reduece the size of the opening. By doing the wrap, they increase the diameter of the esophagus--just like installing a bushing!!! That also causes the contractions of the stomach during digestion to help the LES close off the esophagus to prevent stomach acid from leaking into the esophagus.

As I said above, I had both the HH repair and the wrap and had an easy recovery--and I am an old "dude"--73 when I had the operation......I was blessed being back to my normal routine in three weeks.

liang7079

A HH like other hernias don't really heal on their own. In order to heal it has to be held together. The sutures they use aren't the only way it is repaired. It's a temporary fix and the scarring is what really holds it together with the help of the sutures.

The people who you have heard from that have bad issues with the wrap, were they from the internet mostly? If so you have to remember this. People who have the surgery and have good results almost never post about it, but someone who has a problem will post everywhere. Even these people usually end up with good results later on down the road once everything has healed.

That is what makes this site so different. A lot of us decided to stick around and tell our story of success. I could have just moved on with my life after I healed, but I got so frustrated only reading about the horrors of this surgery I wanted to let people know there as someone who has been through some of the worst issues and complications that ended up with great results.

If you go to the resources page at the top of the forum you will see Denise's and I's stories about our surgery. Mine includes my complications and about my esophagus tear from an EGD. I don't think there is a much worse scenario than having a tear of the esophagus, just about loose your esophagus and your wrap blown apart only to have it finally heal and have a redo that is working great over 2 years later. That was the worse 8 months of my life.

Take care,
Bill

Thanks for the replies - Well different surgeons will have different opinions, at this discussion you get exactly that:

http://www.generalsurgerynews.com/ViewArticle.aspx?d_id=67&a_id=14778

It would probably make more sense to use a biologic mesh to prevent the reoccurence of HH, here is a paper supporting that:

(difference between 16% to 0% in 2 groups without and with mesh)

http://www.sages.org/meetings/annual-meeting/abstracts-archive/hiatal-hernia-repair-with-biologic-mesh-reinforcement-reduces-recurrence-rate-in-small-hiatal-hernias/

Also the current practice of automatically performing fundoplication on patients undergoing HH repair should probably be reviewed and considered individually, as many patients (especially ones with small HH) probably don't really need it? (especially with the potential side effects fundos can bring) Would it make more sense to measure the LES pressure and function and observe symptom improvement after HH repair and do the fundo if really needed (although for practical reasons no surgeons or patients would probably do this)?

diaba

I think most surgeon's logic is to do them both in 1 surgery vs. seeing what happens and possible 2 surgeries.

Take care,
Bill